Policies for Inclusive Health in Post COVID -19 Africa: Summary … · 2 days ago · seminar in collaboration with the World Health Africa Development Bank Group An inclusive health

©African Development Institute, African Development Bank Group--[1]

Policies for Inclusive Health in Post COVID -19 Africa:

Summary Outcomes of the African Development Institute

(ADI) Global Community of Practice (G-CoP) e-Seminar, 22 and 23 June 2020.

Kevin Chika Urama1 Eric Kehinde Ogunleye2, Njeri Wabiri3

INTRODUCTION: Health is the prerequisite for

life, economic productivity and every human

experience. Health is local. Global agendas and

global policies need to be domesticated and adapted

to local conditions. Investing in health is investing

in lives and economies. Africa needs to own its knowledge and its discoveries for the health and

well-being of its citizens.

Yet many African countries have not fully

prioritized investments in inclusive health and

wellness in their development policies and programs

over the years. Africa’s health policies have mostly

focused on “consumptive” rather than “productive”

health – a colonial principle that prioritized “health

care” as management of disease outcomes over “the

provision of public health services” that prioritize

inclusive health and wellness from conception to the

end of life. Health pandemics have therefore

continued to plague African countries

disproportionately compared to other regions of the

world. HIV/AIDS, coronary diseases, respiratory

diseases, lassa fever, malaria, tuberculosis, etc., are

longstanding pandemics in Africa. Put together,

these ‘pandemics’ kill many more Africans daily

than does COVID-19.

Delegates of the African Development Institute

(ADI) Global Community of Practice (G-CoP)

policy seminar held on 22 and 23 June 2019, called

for a Marshal Plan for an inclusive resilient health

system in Africa. There is need to build an

1

Senior Director, African Development Institute (ADI), African Development Bank Group 2

Advisor to the Chief Economist /Vice President, Economic Governance and Knowledge Management/OIC Manager Policy

Management Division, African Development Institute, African Development Bank Group. 3

Consultant, African Development Institute, African Development Bank Group.

integrated system that strengthens human health

and wellness, able to detect and interpret local

warning signs and quickly mobilize internally to

absorb the shocks, isolate threats, and transform

itself to adapt to shocks; and organically innovates

new ways to maintain its core functions today and tomorrow.

The two-day e-policy seminar held on 22 and 23

June 2020 for delegates from the Western and

Eastern hemispheres, respectively – brought

together over 565 global experts and 69 panelists

from 50 nationalities (Annex 1).

The African Development Institute (ADI) of the

African Development Bank Group hosted the

seminar in collaboration with the World Health

Africa Development Bank Group

An inclusive health system is shaped by

interactions amongst several spheres of

the human experience: the food system,

water and sanitation, social environment,

education systems, the physical

environment and infrastructure,

including the quality of the human

habitat, health infrastructure, social

infrastructure, and the environment, that

inform the disease emergence, disease

management and control system in a

society

©African Development Institute, African Development Bank Group- [2]

Organization (WHO); The African Centre for

Disease Control (CDC); The Bank Group’s Health

Department (AHHD) and Health Centre (CHMH);

African Population and Health Research Center

(APHRC); Murdoch University, Western Australia;

Drexel University (School of Public Health) USA;

City University of New York (School of Medicine)

USA; University of Nigeria (Faculty of Health

Science and Technology).

Key panelists included a Minister of Health from

Western Australia, former Ministers of Health,

Education and Finance from Africa, a

Commissioner for Health, technical staff of Prime

Minister’s Offices, specialists from multilateral

institutions such as Africa CDC, WHO, World Bank

Group, University Vice-Chancellors, and heads of

health policy research institutes, Teaching

Hospitals, think tanks, professional associations,

and private sector leaders.

The Background

Human health is shaped by the human experience,

the broader socio-economic, psychological, and

environmental systems of interaction with the

human genome and the human phenome. Empirical

evidence suggests that differences in the human

genome and the human phenome might explain the

differences in the severity of the symptoms observed

in COVID-19 patients. A resilient and inclusive

health system goes beyond the end of the pipe

approaches to treating disease conditions to reduce

morbidity and mortality. It encompasses the full

cycle of conditions that prevent disease emergence,

contain disease occurrence, manage health and

wellness, and reduce morbidities and mitigate

mortalities from disease-causing agents throughout

the life cycle. It was noted that such a system must

be informed by institutions and governance systems

that are absorptive, adaptive, reflexive, and

transformative1.

The Experts at the G-CoP seminar called for a

radical shift in Africa’s health policy from one that

focuses on medical outcomes, to one that focuses on

the broader concept of inclusive health – ensuring

quality health from conception to end of life, to all

people and all the time.

The State of Health and Wellness in Africa

Africa has made progress in reducing premature

mortality and prolonging life expectancy since the

year 2000 but still lags other regions of the world in

almost all indicators of health and wellness. Life

expectancy increased by an average of 5 years per

decade since the year 2000; Under-5 and maternal

mortality rates have equally fallen by 54.2% and

40.7%, respectively2. Maternal Mortality Ratio

(MMR) declined at an average 0.9% per annum

from 542 to 421 per 100,000 live births between

1990 and 2015; and communicable diseases

(malaria, measles, and HIV/AIDS) substantially

declined since 1990.

However, health services have not been equitable.

The heath of Africans, the health of black people

and other races around the world presents a tale of

multiple worlds. There is a 14-fold difference in

under-five mortality between high income and low-

income countries (most of which are in Africa)3; and

access to all forms of health care is skewed against

the poorest people4 (most of whom are in Africa

and/or are black people in other countries). Africa

and the Middle East have high rates of deaths due to

cardiovascular disease; Africa has the highest rate of

death from tuberculosis; Africa and India have the

highest rates of deaths from diarrheal diseases in

2017; and Africa has highest death rates from

HIV/AIDS and Malaria, and lowest life expectancy

in years than other regions5. The overall COVID-19

mortality rate for Black Americans is 2.4 times as

“Africa urgently needs a “Marshal

Plan” on inclusive one-health policy in

Africa. If we focus on what is, we are

condemned to repeating what was. But if

we focus on what is possible, we stand a

chance of transcending what is. Africa

must learn from its experiences and

unlearn the received wisdom from its

colonial history and build its one health

system – one that is adapted to its

contexts, cultures, and realities”.


high as the rate for Whites and 2.2 times as high as

the rate for Asians and Latinos6. Available evidence

suggests that without transformative policies and

investments, the third Sustainable Development

Goal (SDG 3) on “Ensuring healthy lives and

promoting well-being for all at all ages” is unlikely

to be achieved in Africa. Without Africa, this SDG

will not be achieved globally.

Yet, Africa’s health systems have not been

prioritized over the decades. Early warning signs of

increasing vulnerability of African citizens to

disease prevalence and higher morbidity and

mortality rates from pandemics such as COVID-19

appear to have been ignored by policymakers in

Africa and globally prior to the COVID-19

pandemic:

• Africans have high rates of preventable

mortality from non-communicable diseases

(NCDs) and associated pre-conditions,

including unhealthy diets, tobacco use,

inadequate physical activity, and misuse of

alcohol7.

• Sub-Saharan Africa is in the lowest decile in the

mitigation of preventable deaths, with country

scores as low as low as 19%8.

• 85% of all undiagnosed people with diabetes are

estimated to live in Africa7.

• More than 218 million people in Sub-Saharan

Africa are undernourished. The number grew by

44 million in the past 25 years. It could grow to

320 million by 20251.

• Close to 40% of children under five years of age

in Africa are undernourished9.

Health Expenditure in Africa

Public expenditure on health in Sub-Saharan Africa

is less than 5.2% of GDP10 (about 50% of the global

average and about one-third of the 15% agreed by

African Member States in the Abuja Declaration).

Africa is the only region where health expenditure

is expected to decrease to 5.1% of GDP in 203010.

The total health financing gap in Africa is estimated

to be about US$66 billion per annum11. South Asia

and Africa South of the Sahara together account for

over 50% of the global disease burden and 37% of

the world’s population, but only 2% of global health

spending10.

With over 22% of total health expenditure in the

form of Official Development Assistance (ODA),

and some countries dependent on donor money as

high as 50%12, the border closures and the

protectionist policies that countries enacted to focus

first on flattening the COVID-19 disease in their

own countries, has created a perfect storm for

African health systems. Most citizens in Sub-

Saharan Africa pay for healthcare out of pocket and

very high health expenditures have been

documented as being rampant and a major cause of

poverty13. A large proportion of African workers are

in the informal sector and as such are left out of the

private health insurance schemes that mainly focus

on individuals in formal employment. In many

African countries, health insurance coverage is as

low as 5%. Government-supported programs are at

a nascent stage and need to be supported to grow

while limiting leakages in the service delivery

supply chains.

Density of Health Workers in Africa

Compared to the global average of 52.8 health

professionals per 10,000, Africa has 23 health

professions per 10,000 except for 10 of its 54

countries14. Thirteen (13) of the 47 countries for

which data are available have less than five health

professionals per 10,000 population14. The ratio of

nursing and midwifery personnel-to-population is

11:10,000 in Africa, compared to the global average

of 28: 10,00014. Africa has a shortage of 3.6 million

health workers and 50% of the population has no

access to modern health services.

Brain Drain in the Health Sector

The flip side of the human capital challenge in

Africa’s health sector is that the continent exports

up to 70,000 skilled professionals (including

medical professions) to other parts of the World

annually15,16. The percentages of trained medical

professionals emigrating annually from Africa

ranges from 70% from Angola, 59% from Malawi,

57% from Zambia, 51% from Zimbabwe, and over

75% of all trained physicians from Mozambique 11,17. It is estimated that each migrating African

professional represents a loss of US$184,000 to

Africa18. Based on this statistic, we estimated that

Africa might be losing up to US$128 billion and

US$2.1 billion through the emigration of skilled


professionals and medical professionals annually,

respectively. The US$2.1 billion loss to Africa is

other nations’ gain with the financial benefits

amounting to US$2.7 billion to the United

Kingdom, US$846 million to the United States,

US$621 million to Australia and US$384 million to

Canada19.

This phenomenon is also referred to as “brain

drain” from the supply side and “highly skilled

migrants” from the demand side. Most African

emigrants (also referred to as African Diaspora) cite

better infrastructure and policy incentives as the pull

factors that drive them to the more developed

nations. However, recent surveys suggest that over

60% of the African Diaspora are keen to return to

Africa and the rest are keen to contribute to African

development from their duty stations in the

Diaspora, if there is a reliable platform to facilitate

and securitize their re-engagement.

It is estimated that Africa spends about US$4 billion

annually on the salaries of over 100,000 foreign

experts. 18,20 In effect, Africa is subsidizing the

skilled workforce out of Africa and paying for

international experts to fill the skills gaps created by

the African emigrants. The G-CoP experts noted

that the demographic structure of Africa – notably

its youthful population – could be strategically

harnessed to facilitate continued export of human

capital to support development elsewhere. In a

globalized world, this could be beneficial to both

sides, but strategic policies for re-engaging the

4 Exact estimate of the cost of medical tourism to African economies was not available at the time of drafting this summary outcome of

the seminar,

African Diaspora in African development is

required.

There is need to review the WHO’s code of practice

on international recruitment of health care workers,

adopted in 2010, to tackle problems caused by

demand-led drivers of brain drain from developing

to more developed nations at the detriment of the

former. The current code of practice is a moral guide

rather than an enforceable legal instrument.

Africa is also largely missing in the medical tourism

industry currently estimated at US$100 billion with

a projected growth rate of 15% to 25% in

destinations that have implemented best

practices21,22. Many African elites and public

officials spend billions of dollars in patronizing

hospitals outside the shores of Africa annually4.

Africa’s Footprint in the Pharmaceutical

Industry

The G-CoP experts also noted that Africa is not

pulling its weight in harnessing its rich biodiversity

in vaccine discoveries and the development of

pharmaceutical products. Africa’s share of the

global pharmaceutical industry, which is estimated

to be worth US$1.57 trillion by 2023, is only

2.96%23. While Africa contributes nearly 25% of the

world trade in biodiversity, the continent is largely

missing in the race for vaccine and drug discovery

for several disease conditions that plague the

content24.

In addition, while over 90% of citizens in some

African countries and over 80% of the emerging

world’s population rely on traditional medicine25,

ethnomedicine (also referred to as traditional

medicine) is regarded with disdain in most African

countries. Yet the ratio of traditional healers to the

population in Africa is 1:500 compared to the ratio

of Medical Doctors to population is 1:40,00025.

African medical curriculum is designed to meet

Western standards to the detriment of African

traditional practices, which might be equally potent.

Africa should explore policy options to

build and retain its health work force

within the shores of Africa; reverse the

brain drain through strategic incentives for

African Diaspora to return to Africa and

encourage brain circulation between

Africa and the rest of the World. Strategic

incentives for the African Diaspora to re-

engage in African development from their

duty stations outside Africa is urgently

needed in post-COVID-19 Africa.


African countries have only 375 pharmaceutical

companies for the population of about 1.3 billion

people, while China and India, with a population of

1.4 billion people each have over 7,000 and about

10,500 pharmaceutical companies, respectively26.

At the time of the emergence of COVID-19

pandemic in Africa in March 2020, there were fewer

than 2,000 functional ventilators in 41 African

countries, while the total number of available

intensive care unit beds in 43 countries on the

continent is less than 5,00027. There is urgent need

for Africa to enact policies and strategies to harness

its wealth in biodiversity rich in medicinal plants,

roots, herbs and other microbes to accurate vaccine

and drug discovery locally.

Health Impacts of COVID-19 in Africa

The health impacts of COVID-19 around the world

in terms of confirmed rates of infection, morbidities

and mortalities as well as geographical spread have

been unprecedented (Box 1). Beyond the widely

reported mortalities and morbidities, emerging

evidence suggests that the impacts of COVID-19

might be triggering and/or amplifying other chronic

disease conditions such as diabetes, cardiovascular

diseases, blood clotting and affecting liver function

in patients. It remains unclear how the disease

curves will evolve and/or if the COVID-19 virus

would mutate into other strains of the coronavirus.

And more importantly, the reported cases are based

on the levels and accuracy of testing in

communities. There is a relatively high number of

asymptomatic careers of the COVID-19 virus who

may be spreading it in communities unwittingly.

These asymptomatic spreaders can only be

identified and quarantined if there is widespread

community testing capacity in countries. In

addition, some of the available test-kits result in up

to 15% false negatives. This can further exacerbate

the community spread of COVID-19.

It was noted that most of the health pandemics

caused by zoonotic diseases such as COVID-19

have resulted from anthropogenic incursions into

natural habitats climate change, trade in wildlife;

biodiversity loss, food insecurity; massive social

inequalities that are driving the poor to the banks of

survival; and a development model that benefits the

few at the detriment of the masses. Until these

sources of disequilibria in the outcomes of the

current development paradigm are decisively

addressed, more pandemics are yet to come1.

Countries are therefore called upon to adopt the non-

pharmaceutical measures recommended by the

World Health Organization – notably personal

hygiene, frequent handwashing, social distancing

and wearing of masks while in public to prevent the

spread of COVID-19 and other communicable

diseases. These basic personal hygiene practices are

needed not only for containing COVID-19 but also

for mitigating other communicable diseases that

affect citizens of Africa.

Impact Transmission Channels of COVID-19

COVID-19 is a supranational pandemic. It has

impacted several spheres of human health and

wellness through several channels:

• Demand shock: lockdowns and loss of incomes

reduce household incomes and affect demand

for Medicare.

• Supply shock: contraction in local production

and export ban limit medical supply.

• Induced price shock: Artificial buying,

hoarding and protectionist policies increase

prices of medical equipment and

pharmaceuticals during a pandemic. The

contraction in production, stranded assets and

incurred debt may lead to sustained price hikes

in the medium term.

• Fiscal balance constraints: Constrained budget

balances in countries, limited and plummeting

internal revenue and foreign exchange earnings

and instability in the value of domestic

currencies caused by easing of monetary and

fiscal policies elsewhere will further limit the

capacity of countries to expand health sector

budgets. Available health budgets reallocated to

COVID-19 could lead to budget deficits for

other sectors, including primary health care,

We can expect a “V”, “U”, extended “U”, a

“W” or multiple “W” shaped recovery in

African countries depending on public

policy options implemented by countries,

until the vaccine for COVID-19 virus or a

therapeutic cure becomes universally

available1


water and sanitation, food and other medical

needs of vulnerable populations.

• Lack of coordination among relevant

Ministries and Governments Agencies: This

could lead to the risk of further budget

constraints in critical sectors as resources are

relocated to importation of testing equipment

and personal protective equipment (PPEs),

leaving key sectors at risk.

• Prevailing conditions: The impact of COVID-

19 is exacerbated by existing health,

demographic and social conditions of patients.

Population density, lack of access to basic

primary health services, food, water and

sanitation, etc., exacerbate the impacts of

COVID-19 in Africa.

COVID-19 Lockdowns are Not Equal

During the COVID-19 lockdowns, hunger

pandemic, domestic violence, and social insecurity

may exacerbate health challenges in many African

communities. Already, it is estimated that about 135

million Africans are experiencing critical food

insecurity. By the end of 2020, upwards of 265

million people could be on the brink of starvation

globally, almost double the current rate of crisis-

level food insecurity28. Children under five years

who survive the hunger pandemic may suffer

stunting and reduced brain development – a

condition that could limit their capacity for life.

In 2018, the proportion of under-5 children who

were not growing well (stunted, wasted, or

overweight) was over 40% in sub-Saharan Africa

compared to just under 15% in developed

countries9. More African children and young people

are surviving, but far too few are thriving.

Malnutrition is both a result and a significant cause

of poverty and deprivation in Africa. The causes of

malnutrition also include poor access to essential

health services and to clean water and adequate

sanitation, which can lead to illnesses that impact

the intake and absorption of nutrients. The number

of undernourished people in Africa grew by 44

million in the past 25 years.

One severely impacted country is the Democratic

Republic of Congo, where over 15 million people

are experiencing acute food insecurity. DRC’s

eastern region is at risk of Ebola re-emergence. In

Eastern Africa, a new generation of locusts has

descended on croplands, wiping out vital food

supplies for millions of people. Weather conditions

could exacerbate the growing swarm of trillions of

locusts into countries that are not normally

accustomed to dealing with the pest. This could

continue to cause significant problems in the region

in 2020.

The confluence of factors will drive rural-urban

migration and social conflicts and confrontations at

the community, state, national and regional scales.

This could drive further protectionism as

individuals, states and countries implement

measures to protect themselves. The majority of

African households already spend more than 40% of

disposable income on food29.

About 4.5 billion people (60% of the world) do not

have access to safely managed sanitation; 15% of

the world still practice open defecation and 40% of

the world does not have access to basic

handwashing facilities. About 400 million Africans

lack access to safe water and nearly 800 million do

not have access to basic handwashing facilities.

Unsafe sanitation is responsible for 775,000 deaths

annually30.

Yet, water, sanitation and personal hygiene are the

first lines of defense against COVID-19. Air

pollution remains one of the greatest environmental

threats to human health. In 2018, 97% of cities in

low- and middle-income countries with more than

100,000 inhabitants did not meet WHO air quality

guidelines31. It is estimated that over 500,000

Africans (mostly women and children) die annually

from indoor air pollution-related illnesses. COVID-

19 lockdown policies must account for these

Continued COVID-19 lock-down could

become a silent war on the poor without

guns if the necessary social safety net

measures are not urgently put in place to

ensure food and medical supplies to the

vulnerable households. This could kill more

than COVID-19 in Africa1.


underlying pre-conditions that are mainly

responsible for how households can cope with

lockdowns and implement personal hygiene and

social distancing measures.

Policies must be informed by localized scientific

evidence on the prevalence of the COVID-19 virus

based on widespread community testing,

epidemiological models of potential spread based on

the demographic factors and underlying socio-

economic factors relevant to the spread of COVID-

19, as well as the resilience capacity of the

populations.

There is no one size fits all policy option.

Decisionmakers need to engage with local experts

and influencers (Scientists, Community Leaders,

Faith leaders, and Civil Society) to articulate clear

policy messages, define incentives, norms or

behaviors, and rules for managing defiance. Policies

to contain COVID-19 is non-pharmaceutical and

behavioral at this stage.

Health outcomes do not trickle down.

Countries must move from a focus on

flattening the COVID-19 disease curve to

more comprehensive measures to flatten

the primary healthcare needs of citizens.

There must not be another return to

business as usual. We cannot contain the

COVID-19 pandemic and/or avert a next

pandemic with the same logic and systems

that got us to this point. Incrementalism

does not work in the health sector. Bolder

action for health in Africa is urgently

required now. Africa needs to unlearn to

learn transformative ways of addressing

the health challenge in Africa in an

African way. To build a resilient health

system post-COVID-19, Africa needs to

refocus its policies on inclusive public

health services not on managing disease

outcomes alone,

Box 1: Health Impacts of COVID-19 as at 22 June 2020

• 8,736,664 COVID-19 confirmed cases globally: 49% in the Americas, 26% in Europe; 21% in Asia.

• Over 4.0 million tests conducted in Africa: South Africa (32%), Morocco (13%), Ghana (7.0%),

Ethiopia (5%) and Egypt (4%).

• Confirmed cases (295,406); Recovered cases (142,261); Mortalities (7,852); Active cases (145,293).

• South Africa, Egypt, Nigeria, Ghana, Algeria, and Cameroon account for 68% of cases reported in

Africa.

• Five countries with the least number of cases are Lesotho, Seychelles, Gambia, Namibia, and Botswana

• As of June 20, 2020, a total of 7,852 deaths were reported in Africa, of which 42.3% are in North

Africa, 24.9% in Southern Africa, 13.7% in West Africa, 11.5% in East Africa and 7.6% in Central

Africa.

• The case fatality rate (CFR) stands at 2.7% for Africa in the review period, compared to 5.3% globally.

Source: African Development Bank, Statistics


INCLUSIVE HEALTH POLICY OPTIONS FOR POST COVID-19 AFRICA

The experts proffered actionable policy options (Box 2) to flatten the COVID-19 disease curve; rebuild an

inclusive and resilient health system for Africa; and improve the health and wellness for the people of Africa.

Detailed analysis of the short-term, medium and long-term policies including their potency, implementation

challenges, and possible solutions will be provided in the Matrix of Policy Options (MPO) and Summary for

Policymakers (SPM) that are currently under preparation5.

5 The list of policy options reflected in this summary benefited from the contributions of the Panelists and Delegates who

submitted think-pieces to the seminar (Annex 2).

BOX 2: Policy Options

• Countries should enforce the non-pharmaceutical measures including personal hygiene,

handwashing, hand sanitizing and use of masks in public places depending on the severity of

COVID-19 in communities.

• Countries to provide social safety nets and essential services for primary health care (access to

quality water and sanitation, food, and basic sanitary services) for vulnerable households.

• Countries to scale up testing, contact tracing, isolation and quarantining COVID-19 positive

patients, social distancing, restricted movement, and border protection to minimize spread of

the virus.

• Proactive knowledge and capacity sharing within the region and globally to better understand

the epidemiology of the virus and impacts of measures being implemented.

• Establish public policy and regulatory frameworks to enhance the digitization of health care;

operationalization of telemedicine, mobile clinics, and innovative /mobile outpatient services in

Africa – address licensing, patient confidentiality and data protection, digital infrastructure and

ICT access, and public participation.

• Development Banks and Financial Institutions should prioritize investments in domestic

capacity for production of medical equipment and pharmaceuticals including vaccine and drug

discovery.

• Finance Ministers to implement prudential macro-economic policies to ensure adequate budget

provision for public health services in countries and fiscal stimulus to support the most

vulnerable citizens.

• Countries to enact Vaccine and Drug Discovery Policy that encourages the public and private

sectors to leverage Africa’s rich biodiversity for the development of pharmaceuticals for the

benefit of Africans and the humanity in general. There should be inward policies to produce

vaccines and drugs locally.

• African Development Bank Group and the African Union Commission and WHO should

initiate a Marshall Plan on Inclusive Health embedded in African realities for Africa. This

should be ratified through a Continental Health Summit of Heads of States and Governments,

Leaders of the Private Sector, the Accademia, and Civil Society.

• Establish African Phenome and Genome Centre – for disease profiling, research, and

development and enhanced precision public health care services in Africa.


[…] Policy Options

• Support Youth and Women Innovation Incubation Program to harness and commercialize social

innovations (e-health, M-health, and other applications) being developed by African youths and

women.

• Strengthen and reform African health policy research institutions to focus on Africa-led

solutions on inclusive health in Africa. This should include the strengthening of science and

technological capacity of the African Centers for Disease Control (CDC), regional public health

Institutes, National health policy research institutions, Faculties of Medicine, Pharmacy,

Biomedical Sciences and related subjects, and policy think tanks.

• Establish policies to build and retain health professionals in Africa, reverse brain drain, and

encourage brain circulation among the African Diaspora.

• Mobilize African Health and Finance Ministers to participate in World Health Assemblies to

drive African agendas at the global scale.

• Invest in Big-Data systems to support medical and epidemiological research that can inform

early warning systems and rapid responses to disease detection, management, and control.

• Refocus attention on community, national and sub-regional health policies. Health is local.

Global policies do not work.

• Countries are encouraged to domesticate and scale up investments in the African Development

Bank Group’s Hi-5 Strategies as a broad framework for building inclusive and resilience health

systems in Africa.

• Focus on Universal Health Care (UHC) policies to ensure that no one is left behind.

• Re-think investments in health care infrastructure to focus on efficiencies, flexibility, adaptive

capacity, and collaboration (through referrals) rather than number of physical infrastructures

built. Invest in inclusive public health system rather than disease specific infrastructure.

• Invest in transparency and accountability systems in the health sector – to reduce leakages and

corruption.

• Enact policies for public-private sector partnerships (PPPs) in the heath sector

• Global cooperation is required as an obligation to our shared humanity, planetary security, and

our common future. If COVID-19 is anywhere, COVID-19 is everywhere.

• Further research on appropriate health technology, digital health, ethno-medicine, data

environment and retroactive learning from earlier pandemics in Africa and elsewhere, and how

other countries have addressed COVID-19 is required.

• Inclusive Health Insurance Policy Required across countries is required

• Invest in basic public education and reform curriculum to address African realities.

• Invest in policies for behavioral change

• Response policies should be guided by science not politics


POLICY TIMING, DESIGN, AND

IMPLEMENTATION

Whichever policy options are chosen, countries

should pay attention to the policy design,

sequencing, relevance to local conditions, and the

timing of implementation.

Poorly designed recovery policy is likely to be

ineffective in delivering desired economic outcomes

regardless of theoretical potential. Countries are

advised to avoid “copy-pasting” policies designed

for other contexts such as the “lockdown” policy.

Policymakers should proactively engage local

experts and scientists to help them identify the

appropriateness of policies in their local conditions.

Furthermore, policymakers should map out the

potential multiplier effects and co-benefits on other

sectors of the economy at the policy design stage. It

was noted that a lack of capacity for policy

implementation is also an ongoing concern on the

continent. Policy design should include clear

indicators of accountability and strategies for

monitoring progress to maximize impact. National

contexts and priorities differ and so should the

polices targeted at addressing them.

The G-CoP experts noted that policy timing,

timeliness and flexibility in implementation will be

important characteristics for achieving the desired

outcomes. In the context of COVID-19, there are

many known unknowns and unknown unknowns. It

is yet unclear how long the pandemic will last and

whether there will be recurrence after the first cycle.

With the current nationalistic approaches to the

prevention and containment measures, it is very

likely that hotspots of the virus may remain in less

developed countries, especially in Africa, for much

longer. These could become future epicenters for

another global spread of the virus. In addition, it

remains unclear whether the estimated recession

will be deeper than projected with possible default

cascades.

The discussion on the shape of the recovery of the

economies remains unclear. It is yet to be seen

whether economies will take the “V”, “U”,

prolonged “U” or even a “W”, multiple “W” or “L”

shaped recovery path. Without a coordinated global

action, the recovery path may likely be a multiple

“W”, if there are multiple waves in the future.

While extreme urgency was required in introducing

prevention and containment policies that were

sometimes inappropriate for local conditions,

successful policies for the recovery and rebuilding

phase will be defined by the appropriateness of the

specific policies adopted to specific social, political,

environmental, and financial contexts of actors.

Equity considerations demand that recovery policies

should not pass on significant liabilities across

nations and/or to future generations.

Intergenerational inequities will be exacerbated

within and among countries, if policy responses to

pandemics such as COVID-19 focus on re-booting

unlimited consumption and/or rebuilding national

economies only. The COVID-19 lockdown and

social distancing policies have exposed the

significant inequities in the current economic

system, which focuses on maximizing current

consumption to maximize GDP growth without

much recourse to the distribution effects of policies

ad externalities of social and natural capital, and the

overall welfare of the current and future generation.

The G-CoP experts encouraged African

governments not just to focus on rebuilding the

health system but to build inclusive health systems

– one that focuses on sufficiency, efficiency,

adaptive capacity, inclusiveness, and equity.

COVID-19 has renewed the appreciation of basic

hygiene and public healthcare services. This should

be maintained even after the COVID-19 pandemic.

Contact: African Development Institute, Global

Community of Practice,

e-mail: [email protected]

COVID-19 is a supra-national health

pandemic. It requires a supranational and

coordinated global response. If there is

COVID-19 anywhere in the world, there is

COVID-19 everywhere in the world.

mailto:[email protected]


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Annex 1: Global Distribution of Delegates for the Seminar

https://www.afro.who.int/news/covid-19-pandemic-expands-reach-africa

https://ourworldindata.org/grapher/share-of-consumer-expenditure-spent-on-food-vs-gdp-per-capita

https://www.who.int/airpollution/data/cities/en/


Annex 2: List of the Panelists, the Delegates who submitted think-pieces to the Seminar

Dr. Matshidiso Rebecca Moeti

WHO Regional Director for Africa

World Health Organisation

Brazzaville, Republic of Congo

Dr. Ahmed E. Ogwell OUMA

Deputy Director, Africa CDC

Africa Centers for Disease Control and

Prevention, Ethiopia

Professor Prof. Emmanuel Akinola Abayomi

Honorable Commissioner for Health,

Lagos State

Nigeria

Hon Roger Cook BA GradDipBus MBA MLA

Honourable Deputy Premier; Minister for

Health; Mental Health

Western Australia.

Dr. Olusoji Adeyi

Senior Advisor for Human Development.

former Director of the Health, Nutrition, and

Population (HNP) Global Practice

World Bank

Prof. Sharon Fonn

Professor, Public Health; Former Head of

School,

University of the Witwatersrand,

South Africa

Prof. Tolib Mirzoev

Associate Professor of International Health

Policy and Systems

Head of Nuffield Centre for International Health

and Development

University of Leeds,

United Kingdom

Professor Tollulah Oni

co-Director, Global Diet and Activity Research

group

MRC Epidemiology unit, Clinical Senior

Research Fellow

Cambridge University Cambridge

United Kingdom

Dr. Ties Boerma

Head of the Countdown to 2030 Initiative,

University of Manitoba,

Canada

Dr. Humphrey Cyprian Karamagi

Health Systems Development specialist, WHO

Regional Office for Africa, World Health

Organisation,

World Health Organization


Prof. Mouhamdou Guelaye Sall

Dean of thé Faculty of Health Sciences

University Hampate Ba Dakar Sénégal

former Director Institute for Training and

Research in Population, Development and Health

Reproduction (IPDSR) Cheikh Diop University

Dakar, Senegal

Prof. Romain Murenzi

Executive Director, The World Academy of

Sciences, former Rwanda's Minister of

Education, Science and Technology, and

Scientific Research,

former Minister in the President's Office in

Charge of Science and Technology, and

Scientific Research

Trieste, Italy

Dr. Catherine Kyobutungi

Executive Director,

African Population and Health Research Center

Nairobi Kenya.

Prof. Igwe Charles Arizechukwu

Vice-Chancellor

University of Nigeria

Nigeria


Prof. Cajetan Onyedum

Professor of Medicine /Consultant Physician

College of Medicine,

University of Nigeria Enugu Campus Nsukka,

Nigeria

Mazi Samuel I. Ohuabunwa

OFR,MON,NPOM

President, Pharmaceutical Society of Nigeria;

Former Chairman, Nigerian Economic Summit

Group

Nigeria

Dr. Githinji Gitahi, MBS

Group Chief Executive Officer,

AMREF Health Africa

Nairobi Kenya

Dr. Margaret Agama-Anyetei

Head of Health, Nutrition, and Population,

African Union Commission

Ethiopia

Prof. Ementa Hyacinth Ichoku

Vice Chancellor - Veritas University, Abuja.

Former Acting Director Academic Planning

University of Nigeria,

Nsukka

Prof. Obinna Onwujekwe

Lecturer/Researcher

University of Nigeria

Nsukka, Nigeria

Dr Amit N Thakker

Executive Chairman |Africa Health Business,

President |Africa Healthcare Federation

Nairobi, Kenya

Dr. Funmi Adewara

Founder and CEO

Mobile Health International

London, United Kingdom

Prof. Ashiwel S. Undieh

Professor, City University of New York (CUNY)

School of Medicine

Formerly Vice President and Associate Provost

for Research and Graduate Studies

City University of New York, City College

United State of America

Dr. Nihinlola Mabogunje

Team Leader-Support to National Malaria

Programme (SuNMaP2/MC); Senior Policy

Advocacy Advisor- Palladium Integrated Health

Project, Health Policy Plus

Abuja Nigeria

Prof. Chris Smith

British consultant virologist and lecturer.

fellow of Queens’ College, Cambridge

University

Sir Walter Murdoch Distinguished Professor of

Science Communication

United Kingdom

Dr. Ana Rita Sequeira

Academic Chair | Health Administration, Policy

and Leadership Program Murdoch Business

School College of Arts, Business, Law and

Social Sciences

Australia

Dr Adetoun Mustapha PhD, DIC, MPH

Adjunct Researcher

Nigerian Institute for Medical Research

Edmund Crescent

International Society for Environmental

Epidemiology Africa Chapter

Lagos, Nigeria

Mr Genadiev Ivan

Kingdom Managing Director & COO

Alta Semper Capital

London United Kingdom


Dr. Prosper Tumusiime

Acting Director, Universal Health Coverage &

Life Cycle, Cluster,

WHO Regional Office for Africa, World Health

Organisation


Prof. Irene Agyepong

Director, RDD/Lecturer/Researcher, Ghana

Health Service; University of Ghana School of

Public Health

Ghana

Prof. Francis Omaswa

Executive Director, African Centre for Global

Health and Social Transformation (ACHEST)

Former Director General for Health Services

in the Ministry of Health in Uganda

Uganda

Prof. Jeremy Nicholson

Pro-Vice Chancellor Future Health Institute

Murdoch University

Western Australia

Nwadiuto Esiobu Ph.D.

Professor, Microbiology and Biotechnology

Florida Atlantic University

Jefferson Science Fellow, US Department of

State Florida,

USA

Dr. Bahati Moseti

Emergency Physician

Telemedicine expert in rural and remote

Australia and member of African Diaspora in

Australia.

Australia.

Professor Elaine Holmes

Fellow of the UK Academy of Medical Sciences,

Murdoch University,

Western Australia.

Prof. Alex Ezeh

Dornsife Professor of Global Health

Dornsife School of Public Health

Drexel University, United States

Mr. Simons Bright

President mPedigree

Accra Ghana

Ghana

Professor David Doepel,

Former Deputy Vice Chancellor-Research

and Innovation, Murdoch University / Chair

Africa-Australia Research Forum, Perth,

Western Australia

Professor David Morrison

Deputy Vice Chancellor Research and

Innovation, Murdoch University,

Australia

Ms. Margareth Ndomondo-Sigonda, M.Sc.,

M.B.A.

Head of Health Program

African Union Development Agency

AUDA-NEPAD

South Africa

Prof. Abdoulaye Djimdé, FAAS, FMAS

CAMES Professor, Parasitology-Mycology.

Director, MRTC-Parasito

Malaria Research and Training Center

Department of Epidemiology of Parasitic

Diseases Faculty of Pharmacy University

of Science, Techniques and Technology of

Bamako, Mali

Pamela Suzanne Drameh

Coordinator - External Relations, Partnerships

and Governing Bodies unit (EPG), WHO

Regional Office for Africa



Prof. Benjamin Uzochukwu

Professor, Public Health Physician

University of Nigeria Nsukka,

Enugu Campus

Nigeria

Prof. Rhonda Marriott

Ngangk Yira: Research Centre for Aboriginal

Health and Social Equity. Murdoch University.

Pro Vice Chancellor Aboriginal and Torres Strait

Islander Leadership; and Centre Director

Murdock University

Australia

Prof Kevin Chika URAMA, FAAS

Senior Director,

African Development Institute (ADI),

African Development Bank Group (AfDB)

Dr Martha Phiri

Director,

Human Capital, Youth and Skills Development


Dr. Eric K. Ogunleye

Advisor to the Chief Economist & Vice

President Economic Governance and Knowledge

Management

African Development Bank Group

Dr. Njeri Wabiri

Consultant



Mrs. Kwamina-Badirou Kamaria


African Development Bank (AfDB)

Documents

Policies for Inclusive Health in Post COVID -19 Africa: Summary … · 2 days ago · seminar in collaboration with the World Health Africa Development Bank Group An inclusive health